早发型和晚发型新生儿败血症病原菌及临床特征

Clinical features and pathogenic bacteria distribution of neonates with early-onset and late-onset sepsis

目的 分析早发型和晚发型新生儿败血症的临床特点、病原菌及非特异性指标。方法 选取2018年4月-2021年4月海南省妇女儿童医学中心收治的早发型新生儿败血症36例(EOS)、晚发型新生儿败血症(LOS)62例,分别记为EOS组、LOS组,比较其临床特征、检出病原菌、药敏试验结果及非特异性指标、预后。结果 EOS组早产、低体质量发生率低于LOS组,母亲胎膜早破、羊水浑浊及新生儿窒息、低血糖发生率高于LOS组(P<0.05);EOS组黄疸、呻吟、呼吸困难、反应低下、奶潴留发生率高于LOS组,而发热、纳差发生率低于LOS组(P<0.05);EOS组肺炎克雷伯菌检出率低于LOS组(P<0.05);本次检出20株革兰阳性菌对万古霉素、利奈唑胺、替考拉宁均敏感,对青霉素、红霉素、克林霉素、头孢西丁耐药,27株革兰阴性菌中对亚胺培南、美罗培南、阿米卡星、哌拉西林、阿莫西林、氨曲南、头孢曲松、头孢噻肟、头孢他啶、头孢吡肟耐药株数均不超过10株;两组白细胞计数(WBC)、C-反应蛋白(CRP)、超敏C-反应蛋白(hs-CRP)、中性粒细胞计数百分比(NE%)无差异,EOS组血小板计数(PLT)低于LOS组,而平均血小板体积(MPV)高于LOS组(P<0.05)。结论 EOS及LOS患儿均有一定临床特点,尤其在临床表现、病原菌种类、非特异性指标方面有一定差异,早期识别对其诊断有重要意义。

OBJECTIVE To analyze the clinical features, pathogenic bacteria and non-specific indicators between early-onset and late-onset neonatal sepsis. METHODS Total of 36 neonates with early-onset sepsis(EOS) and 62 neonates with late-onset sepsis(LOS) who were admitted to Hainan Women and Children′s Medical Center between Apr 2018 and Apr 2021 were recruited. The clinical features, pathogenic bacteria distribution, results of drug sensitivity test, non-specific indicators, and prognosis between the two groups were compared. RESULTS The incidences of premature birth and low weight in the EOS group were lower than those in the LOS group. The incidences of maternal premature rupture of membranes, turbid amniotic fluid, neonatal asphyxia, and hypoglycemia in the EOS group was significantly higher than those in the LOS group(P<0.05). The incidences of jaundice, groaning, dyspnea, decreased responsiveness, and milk retention in the EOS group were significantly higher than those in the LOS group, while the incidences of fever and anorexia were significantly lower than those in the LOS group(P<0.05). The detection rate of Klebsiella pneumoniae in the EOS group was significantly lower than that in the LOS group(P<0.05). The 20 strains of Gram-positive bacteria detected in this study were sensitive to vancomycin, linezolid and teicoplanin but resistant to penicillin, erythromycin, clindamycin and cefoxitin. Among the 27 strains of Gram-negative bacteria, less than 10 strains were resistant to imipenem, meropenem, amikacin, piperacillin, amoxicillin, aztreonam, ceftriaxone, cefotaxime, ceftazidime and cefepime. White blood cell count(WBC), C-reactive protein(CRP), high-sensitivity C-reactive protein(hs-CRP), and neutrophil percentage(NE%) between the two groups showed no differences. However, the platelet count(PLT) in the EOS group was significantly lower than that in the LOS group, and mean platelet volume(MPV) was significantly higher than that in the LOS group(P<0.05). CONCLUSION Children have some differences in clinical features, such as clinical manifestations, types of pathogenic bacteria and non-specific indicators between the EOS group and LOS group. Early identification is the most significant for diagnosis.